Repeat C-Section May Have Same Health Outcomes as VBAC

Good news for moms who've had multiple C-sections—a new study has found babies' long-term health is the same as those born via VBAC (vaginal birth after cesarean).

Repeat C-Section May Have Same Health Outcomes as Vaginal Birth Scott Dumas/Shutterstock

If you're pregnant after a previous C-section, you're probably debating the best way to birth this baby. Although most moms opt for planning a repeat C-section, a VBAC (vaginal birth after Cesarean) is an option gaining momentum, given the push to reduce the number of C-sections. But, which is really the best choice? A new study published in the journal PLOS Medicine found that when it comes to baby's long-term health, it's a toss-up.

No real difference in risks

Researchers looked at data from over 40,000 women who had a previous C-section. Of those, almost 45 percent had a scheduled repeat C-section, 22 percent had an unscheduled C-section and 33 percent had a VBAC for their second child. "The most common reason for performing a planned Cesarean section is a history of a previous C-section," Mairead Black, OBGYN, of the University of Aberdeen in the UK, tells Fit Pregnancy. "However, there is very little information available on childhood health outcomes of birth after a previous C-section." So, the researchers set out to look at the children's long-term health, including their risk of obesity, hospitalization for asthma, use of an inhaler for asthma, irritable bowel disease, type 1 diabetes, learning disability, cerebral palsy, cancer and death.

Of all of these negative outcomes, Dr. Black found only a slightly elevated risk for hospitalization for asthma in children born by repeat C-section (36-37 per 1,000 children) compared to vaginal birth (33 per 1,000). Also, learning disability and death were slightly more common following an unscheduled C-section, but not a scheduled C-section.

Weighing risks and benefits

Because C-section babies aren't exposed to the "good" bacteria in mom's vagina, their gut and immune development may be affected, leading to an increase in immune-related diseases like obesity and asthma. But although "this study further suggests that C-sections may contribute to global increases in asthma," Dr. Black says that shouldn't affect a woman's choice. "The absolute increase in risk of asthma to children delivered by repeat C-section was very low, so it is unlikely to be important enough to influence individual delivery decisions, where other factors should take priority," she says. Even if C-sections cause asthma, "298 successful vaginal births would be required to avoid one case of hospitalization with asthma."

Although VBACs have a success rate of 65 to 75 percent, they carry a .5 percent risk of uterine rupture, which could put baby at risk as well as mom. Unscheduled C-sections are often failed VBAC attempts, so the higher rate of learning disability and death among that group may have been the result of difficulties during labor, but Dr. Black says we can't be sure. "This study is unable to confirm whether the learning disability and death risks relate to scar rupture or other complications in labor leading to an unscheduled Cesarean section," she says. "It is possible that these risks may be explained by problems with the mother or unborn baby's health, which led to an unscheduled pre-labor Cesarean section."

If you've had repeat Cesareans, rest assured: C-sections and VBACs each have their own pros and cons, but this study shows the differences for children's long-term health are negligible. If you're currently pregnant after a prior C-section, talk to your doctor to see if you are a candidate for a VBAC, or if a repeat Cesarean is right for you. "Women should make a decision on birth mode after C-section by weighing up the risks and benefits of each birth plan, focusing on the outcomes and experiences which are important to them," Dr. Black says. "They should feel supported in discussing their birth options openly with their care providers."